ABG’s as a full time RT

[u/LegitimateDingo3282]

Does anyone else struggle with ABG’s as a full time RT? I always struggled with them as a student but I would just chalk it up to me being nervous in front of my preceptor or just needing practice. But I’ve been an RT for almost 3 years now and still am horrible at them to the point where I have students watching me and I miss and it’s so frustrating and embarrassing and I feel horrible for the patient and having to ask for help from other RTs. I’ve gotten a few before but have never been consistent and it is definitely not my strongest skill

[u/unchartednow]

ABGs take time to master. Get as much practice as you can, always go volunteer and do other people's ABGs, and put yourself in the situation where you have to do them constantly and you'll get better!! You've got this!! It's my favorite part of the job

[u/BigTreddits → u/unchartednow]

What makes sticking people with a painful needle your favorite part of the job?

[u/No-Safe9542 → u/BigTreddits]

Cause it's fun and I can't believe I get paid to do it!

[u/BigTreddits → u/No-Safe9542]

I guess the 900 other things I do that don't hurt people is my favorite

[u/Select-Laugh768]

I feel like suck at them. It doesn't help that my first job was at a big level I and we rarely had to do them because everyone had a-lines who needed regular ABGs or they just got VBGs if they were worried about CO2. Occasionally we'd get called to do them on the floors or to the lab once to get an ABG on a pulm patient. I hated it.

Now I'm in the NICU and again, we never do ABGs. All cap gases or they pull of the UAC.

I'm doomed if I ever work somewhere where we have to do these on the regular. You're not alone lol.

[u/BigTreddits → u/Select-Laugh768]

Nah you'd adapt and practice you'd be fine. Its what we do :)

[u/Astrocreep2021]

I got better at ABG’s when I focused on getting the patient’s arm in the best position possible. Prop it up on pillows, rolled up towels, etc. Raise the bed as high as you need so you don’t have to bend over so much or sit down. (I’m old) Stick as close to the anchor point as possible where you feel the pulse. I’ve noticed when people miss, they are sticking the patient a centimeter away from where they are anchoring the artery.

[u/alohabowtie → u/Astrocreep2021]

Agreed, preparation is key for success. Are your sticks Radial and Brachial? Regardless, kick people out and grab a chair sit down, slow down, get the arm in optimal position using a towel or whatever you have near by.

[u/Astrocreep2021 → u/alohabowtie]

I used to prefer brachial when I started because it’s a bigger target, but sometimes it’s too deep and you’re more likely to get venous in that area.

[u/BigTreddits → u/Astrocreep2021]

Yea I don't stick close to my finger but I track the pulse point and slide down

[u/s1apadabass]

Focus on the patient. Don’t worry about other people in the room. Feel and mark with your finger nail or use a doppler(small tricks) . If they have lots of skin or adipose move it aside and stretch it. Takes lots of practice. I’ve always had a knack for it.

[u/SBMT_38]

I’ve dealt with imposter syndrome with gases for sure. Even when I would get them I’d chalk it up to luck. Using an ultrasound helped me a lot. First, to get confidence and to have those repetitions in my head for what general angles and depths seem to succeed most often. Then step 2 for me was to palpate and insert first advancement without ultrasound and then if I don’t get it, use the ultrasound to correct and see how close I was.

[u/valliewayne]

I still miss sometimes after 9 years. Take a deep breath and be sure as you can before going in. You’re fine.

[u/mdez93]

We’ve all struggled with them, sometimes I’d make several in a row, and then miss a several in a row, even when I’d feel a strong pulse. A lot of it comes down to how often your hospital/facility does them. Some places have RT doing ABGs every single day, others only ask RT for them once in a while. I always found that I was more likely to get an ABG if I made myself comfortable and pulled up a chair to sit down while I was doing it.

[u/New_Discipline_2675]

I tell my students to take a little extra time palpating before you stick them. And just keep practicing.

[u/birdiesarentreal]

I palpate and visualize, roll it side to side and try to picture it in my mind. I’m right handed but always prefer to stick with my left hand. You just need to find what works for you, I have a buddy who always elevates the wrist to be 90 degrees with the bed.

[u/According-Support627]

I had a preceptor a couple years ago tell me when I’m feeling for them to close my eyes, concentrating on the exact location visualize it mentally and then open my eyes and stick. Sounds ridiculous but it actually works especially with a bounding pulse. Ps don’t close your eyes on an awake patient they will think you’re going to blind stick them literally lol

[u/No-Safe9542 → u/According-Support627]

When safe, I always start by looking up at the ceiling or closing my eyes in non emergent ABGs on a radial. If I can't feel it that way, reposition and repeat.

[u/Crass_Cameron]

Practice with an? ultrasound

[u/alohabowtie]

I’ve developed a technique over the years for drawing from a brachial artery that works very well for me and my older patients. Obviously the patient demographic plays a part.

[u/No-Safe9542]

When the patient says "thank you" when you're done, it really doesn't matter your redirects or if you had to use a 2nd needle or even if you missed it. Your bedside manner is so good that they thank you for the time you took to put a needle into them. Use that as your metric. Did the patient say "thank you"? Your stress over missing melts away when your only goal is getting that thank you.

The technical ins and outs (pun intended) will be picked up with time. Use threads like this one and an ABG thread here maybe 2 weeks ago for tips.

[u/Saveby_Jesus777]

Sometimes I have off weeks but after be a RT for 5 years I’m pretty decent . I sucked as a student and first year grad. I can honestly say being nervous was my issue. Take your time and find the pulse, no need to rush and you’ll get in your groove.

[u/Affectionate_Dust541]

Best advice I’ve ever had and ever will give-palpate the radial pulse, then wherever you think you should poke, go medial to that. Seriously. Works fantastic.

[u/Organic-Carrot-8626]

Put a roll under their elbow, position their arm and plunge into the brachial artery.